Provider Demographics
NPI:1730592775
Name:ECKERMAN, MATTIE
Entity type:Individual
Prefix:
First Name:MATTIE
Middle Name:
Last Name:ECKERMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 MISTY HOLLOW CT
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:MD
Mailing Address - Zip Code:21131-1313
Mailing Address - Country:US
Mailing Address - Phone:443-310-0050
Mailing Address - Fax:
Practice Address - Street 1:2500 OLD WESTMINSTER PIKE
Practice Address - Street 2:
Practice Address - City:FINKSBURG
Practice Address - State:MD
Practice Address - Zip Code:21048-1824
Practice Address - Country:US
Practice Address - Phone:443-310-0050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-07
Last Update Date:2014-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00000292255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer